Atlas of Clinical Sleep Medicine 9780323654036, 0323654037

Table of contents :
Front Cover
Inside front cover
Front matter
Atlas of Clinical Sleep Medicine Third Edition
Copyright
Contributors
Foreword
Preface
Technical details
Polysomnogram recordings
Acknowledgments
Table of Contents
Video contents
Section 1 Sleep in Visual Arts and Literature
1 Sleep in art and literature
Mythology
Religion
Rest
Innocence
Dreams, danger, and death
Bibliography
Section 2 History of Sleep Medicine and Physiology
2 History of sleep medicine and physiology
Timeline
References
Bibliography
Section 3 The Biology of Sleep
3 Sleep mechanisms
Arousal systems
Sleep-promoting systems
Sleep drive
Control of rapid eye movement sleep
Control of the timing of sleep
Bibliography
4 Localization and neurochemistry of sleep-wake physiology and pathophysiology
Introduction
Wake-promoting neurotransmitters
Sleep-promoting neurotransmitters
NREM sleep
REM sleep
External sleep-wake regulation (two-process model)
Homeostasis
Circadian rhythms
Explanatory diagrams
The waking state
NREM sleep
REM sleep
Sleep-wake regulation
Sleep-wake dysregulation in pathologic states
REM behavior disorder
Narcolepsy type 1
Acknowledgment
References
5 Circadian rhythms regulation
Bibliography
6 Physiologic regulation in sleep
Dynamics of individual systems and functional changes in sleep and wake states and across sleep stages
Coupling and network interactions among physiologic systems during sleep and wake states
Acknowledgments
Bibliography
7 Cytokines, host defense, and sleep
Overview of the immune system
Effect of sleep deprivation
Sleep, immune function, and disease
Bibliography
8 Control of breathing
Normal sleep
Sleep apnea
9 Central and autonomic regulation in cardiovascular physiology
Overview
Heart rate surges
Heart rhythm pauses
Physiologic mechanisms underlying nocturnal cardiac events
Summary
Bibliography
10 Interactive regulation of sleep and feeding
Shared brain circuits of sleep and feeding regulation
Shared somatic signaling between sleep and feeding regulation
Metabolic organs modulate sleep-wake activity and feeding
Bidirectional relationship between feeding/metabolic status and sleep-wake activity
Bibliography
11 Endocrine physiology
Overview of endocrine physiology
Ultradian and circadian mechanisms that control hormone secretion across the 24-hour day
Temporal variations of plasma levels of hormones
Glucose regulation and hunger
Conditions that affect hormones and metabolism
Aging
Disease states that reduce slow-wave sleep
Sleep deprivation
Acknowledgments
References
Bibliography
Section 4 Normal Sleep and Its Variants
12 Sleep in mammals
Bibliography
13 Normal sleep in humans
What is sleep?
What is the function of sleep?
Current theories about why we sleep
Restorative theory
Energy conservation theory
Adaptation theory
Memory consolidation theory
Thermoregulatory function theory
Synaptic homeostasis theory
Glymphatic theory
How much sleep is enough?
Neurophysiology of sleep and wakefulness
Wakefulness
Transition between wakefulness and sleep
Sleep mechanisms: From wakefulness to sleep
Transition from wakefulness to non–rapid eye movement sleep
Staging of sleep
Normal circadian function
Normal sleep
Factors that affect sleep
Sleep changes in children
Sleep changes with aging
Sleep characteristics that change with age and their possible neurophysiologic mechanisms
Circadian characteristics that change with age
Bibliography
14 Sleep restriction
Sleep restriction
Recovery from sleep restriction
Individual differences in vulnerability to sleep restriction
Bibliography
15 Sleep and athletic performance
Disordered sleep in athletes
Screening athlete populations for sleep problems
Overscheduling and overtraining
Obstructive sleep apnea
Insomnia and other sleep disorders
Sleep extension
Addressing the sleep needs of athletes
References
Bibliography
16 Dreaming in normal and disrupted sleep
What is dreaming?
Brain basis of dream experience
Factors that influence dream content
Disruption of dreaming pathologic conditions
Sleep disorders
Psychiatric disorders
References
Section 5 Pharmacology
17 Pharmacology
Drugs with hypnotic properties
Zolpidem
Zopiclone and eszopiclone
Zaleplon
Ramelteon
Doxepin
Suvorexant
Diphenhydramine
Sedating antidepressants
Atypical antipsychotics
Ethanol
Agents in development
Wakefulness-promoting medications
Amphetamines and related compounds
Modafinil
Sodium oxybate
Solriamfetol
Pitolisant
Caffeine
Bibliography
Section 6 Impact, Presentation, and Diagnosis
18 Impact, presentation, and diagnostic considerations
Impact
Presentation and diagnostic considerations
Clinical evaluation
History of the present illness
Sleep-disordered breathing symptoms.
Insomnia symptoms.
Excessive daytime sleepiness.
Abnormal sleep-related behaviors and movements.
Medical history
Physical examination
Sleep assessment instruments
Evaluating sleepiness.
Evaluating duration and timing of sleep.
Obstructive sleep apnea risk assessment.
Diagnostic testing
Future considerations: Telemedicine, remote patient monitoring, and beyond
Bibliography
Section 7 Circadian System Disorders
19 Circadian rhythm disorders
Delayed sleep-wake phase disorder
Advanced sleep-wake phase disorder
Non–24-hour sleep-wake rhythm disorder
Irregular sleep-wake rhythm disorder
Shift-work disorder
Jet lag disorder
Summary
Bibliography
20 Circadian desynchrony and health
Circadian system and circadian disruption
Cardiovascular disease
Metabolism
Microbiota
Gastrointestinal disease
Cancer
Conclusions
Bibliography
Section 8 Insomnia
21 Insomnia
Overview
Classification
Epidemiology
Pathophysiology of insomnia
Types of insomnia
Insomnia and comorbidities
Insomnia and other sleep disorders
Isolated insomnia disorder
Management of insomnia
Bibliography
Section 9 Neurologic Disorders
22 Central disorders of hypersomnolence
Overview
Classification and prevalence
Clinical features and epidemiology
Cataplexy
Sleep paralysis and hallucinations
Excessive daytime sleepiness
Disrupted nocturnal sleep
Kleine-levin syndrome
Pathophysiology
Evaluation and diagnosis
Epworth sleepiness scale and fatigue severity scale
Overnight polysomnography, multiple sleep latency test, and maintenance of wakefulness test
Cerebrospinal fluid hypocretin measurement and human leukocyte antigen typing
Other workup
Treatment
Bibliography
23 Movement disorders in sleep
Overview
Restless legs syndrome
Prevalence and clinical significance
Evaluation and diagnosis
Evaluation of severity
Medical evaluation: Iron status
Biology and pathophysiology
Iron
Dopamine
Glutamate
Adenosine
Opioids
Genetics
Treatment
Periodic limb movements during sleep and periodic limb movement disorder
History and definition
Prevalence and clinical significance
Evaluation and treatment
Biology and pathophysiology
Bruxism
Clinical significance
Evaluation
Biology and pathophysiology
Treatment
Sleep-related rhythmic movement disorder
Sleep-related leg cramps
Bibliography
24 Sleep and epilepsy
Introduction
Epilepsy and seizures
Electroencephalography
Types of sleep-related epilepsies
Sleep-related hypermotor epilepsies
Childhood epilepsy with centrotemporal spikes
Childhood epilepsy with occipital paroxysms
Epileptic encephalopathy with continuous spikes and waves during slow sleep
Landau-kleffner syndrome
Primary generalized epilepsies
Normal variants and nonepileptic behaviors
Differentiating interictal discharges from normal variants
Differentiating parasomnia and epilepsy
Other sleep disorders in epilepsy
Conclusion
Bibliography
25 Cerebrovascular disease and sleep
Overview
Breathing patterns after stroke
Pathogenesis of obstructive sleep apnea in stroke
Effect of stroke on sleep
Obstructive sleep apnea as a risk factor for stroke
Bidirectional relationship between obstructive sleep apnea and stroke
Impact of obstructive sleep apnea on stroke outcomes
Diagnosis and treatment of sleep apnea
Impact of obstructive sleep apnea treatment
Summary and future directions
Bibliography
26 Sleep and other neurologic diseases
Introduction
Parkinson disease
Sleep symptoms
Laboratory findings
Treatment
Alzheimer disease
Sleep symptoms
Treatment
Multiple system atrophy
Progressive supranuclear palsy
Huntington disease
Hereditary ataxias
Multiple sclerosis
Paraneoplastic syndromes
Prion disease
Fatal familial insomnia
Creutzfeldt-Jakob disease
Spinal cord injury
Traumatic brain injury
Headache
COVID-19
Conclusion
Bibliography
27 Sleep and neuromuscular disease
Introduction
Impaired respiratory physiology in neuromuscular disease
Common neuromuscular diseases
Motor neuron disease
Spinal cord injury
Peripheral nerve disease
Postpolio syndrome/infectious motor neuropathy
Phrenic nerve injury, neuralgic amyotrophy, parsonage turner syndrome
Neuromuscular junction disease
Muscle diseases
Duchenne muscular dystrophy
Myotonic dystrophy
Chest wall disorders and scoliosis
Compromised breathing mechanics during sleep
Polysomnography findings in neuromuscular disease
Impaired pulmonary physiology and symptoms
Noninvasive ventilation benefits in neuromuscular disease: Physiology and sleep
Longitudinal management of noninvasive ventilation in neuromuscular disease
Conclusion
Bibliography
Section 10 Parasomnias
28 Parasomnias
Overview
Pathophysiology of parasomnias
Disorders of arousal: NREM parasomnias
Rapid eye movement sleep parasomnias
Rapid eye movement sleep behavior disorder
Sleep paralysis
Experiential parasomnias
Sleep enuresis
Nocturnal seizures
Bibliography
Section 11 Sleep Breathing Disorders
29 Examination of the patient with suspected sleep breathing disorders
Overall inspection of the patient
Facial and jaw structures
Inspection of the face
Bony structures
Pervasive facial abnormalities
Maxillary and mandibular insufficiency
Small lower jaw
Nasal airway
Diseases of the nose and nares
Trauma to the nose and nares
Traumatic injury to the nose
Examination of the palate
Examination of the pharynx
Mallampati classification
Examination of the tonsils
Variants and abnormal airway pharyngeal findings
Examination of the neck
Examination of the abdomen
Examination of the extremities
Peripheral edema
Bibliography
30 Sleep apnea in the adolescent and adult
Overview
Definitions
Risk factors
Obstructive sleep apnea
Central sleep apnea
Clinical assessment
Symptoms
Examination
Laboratory evaluation
Data obtained in polysomnography
Scoring of respiratory events with polysomnography
Home sleep apnea testing
Nonapneic respiratory events
Adolescent sleep-disordered breathing
Treatment
General measures
Continuous positive airway pressure
Oral appliance therapy
Surgery
Bibliography
31 Sleep breathing disorders in children
Congenital central hypoventilation syndrome
Obstructive sleep apnea in children
History and physical examination
Historical symptoms of obstructive sleep apnea in children
Common physical examination findings
Technical considerations
Definitions
Obstructive sleep apnea
Mixed sleep apnea
Central sleep apnea
Hypopnea
Respiratory effort–related arousal
Obstructive hypoventilation
Expiratory apnea/hypopnea
Diagnostic considerations
Treatment options for childhood obstructive sleep apnea
References
32 Respiratory diseases and the overlap syndromes
Obstructive pulmonary diseases
Restrictive lung diseases
Extrapulmonary lung restriction
Extrathoracic upper airway obstruction
Bibliography
Section 12 Other Medical and Psychiatric Disorders
33 Cardiovascular diseases
Impact of cardiovascular diseases
Effect of sleep disorders on cardiovascular physiology
Obstructive sleep apnea as a cause of cardiac arrhythmias
Obstructive sleep apnea as a cause of coronary artery disease
Obstructive sleep apnea as a cause of systemic hypertension
Heart failure
Clinical features
Epidemiology
Abnormal breathing patterns in heart failure
Treatment of the abnormal breathing pattern in heart failure
Central sleep apnea
Obstructive sleep apnea
Bibliography
References
34 Thyroid disease
Hyperthyroidism
Hypothyroidism
Thyroid mass lesions
Bibliography
35 Diseases of the pituitary gland
Anatomy
Growth hormone hypersecretion
Pathophysiology
Clinical findings
Diagnosis
Treatment
Hypersecretion of adrenocorticotropic hormone
Pathophysiology
Clinical findings
Diagnosis
Treatment
Bibliography
36 Gastrointestinal disorders
Introduction
Upper gastrointestinal tract
Intestinal motility and lower bowel disorders
Advanced liver disease
Mild liver disease
Bibliography
37 Diabetes mellitus
Sleep quantity and quality and diabetes mellitus
Obstructive sleep apnea and type 2 diabetes mellitus
Prevalence and incidence of concomitant sleep apnea and diabetes mellitus
Mechanisms of development and progression of diabetes mellitus in sleep apnea
Common risk factors and bidirectional relationship between diabetes mellitus and obstructive sleep apnea
Impaired glucose metabolism and pathogenesis of diabetes mellitus in sleep apnea
Complications
Impact of obstructive sleep apnea treatment on glucose homeostasis and diabetes mellitus
Impact of weight loss on obstructive sleep apnea and type 2 diabetes mellitus
Type 1 diabetes mellitus and obstructive sleep apnea
Gestational diabetes mellitus and obstructive sleep apnea
Conclusion
Bibliography
38 Sleep disorders in chronic kidney disease
Background
Definitions and prevalence
Morbidity and mortality
Respiratory sleep disorders
Obstructive sleep apnea
Pathophysiology
Diagnosis
Treatment
Improvement of kidney function.
Improvement of upper airway stability.
Central sleep apnea
Pathophysiology
Diagnosis
Treatment
Improvement of kidney function.
Improvement of ventilatory stability.
Nonrespiratory sleep disorders
Restless legs syndrome and periodic limb movement disorder
Pathophysiology
Diagnosis
Treatment
Insomnia
Pathophysiology
Diagnosis
Treatment
Hypersomnia
Pathophysiology
Diagnosis
Treatment
Bibliography
39 Sleep and psychiatric disease
Overview
Sleep and depression
Sleep architecture
Treatment of depression and sleep problems
Sleep and mania
Sleep, nightmares, and posttraumatic stress
Sleep architecture
Treatment of nightmares in posttraumatic stress
Sleep and generalized anxiety disorder
Sleep and alcohol dependence
Sleep and schizophrenia
Screening for sleep disorders and other medical conditions
Conclusion
Bibliography
40 Sleep and ophthalmologic disorders
Sleep and ophthalmologic disorders
The eye and sleep
Sleep-disordered breathing and ophthalmologic disorders
Circadian rhythm disorders and vision
Insomnia and the eye
Bibliography
41 Sleep and pain
Introduction
Association between sleep and pain
Experimental studies
Restorative sleep and pain
Clinical application
Sleep and pain: Mechanisms
Neurobiology
Psychosocial factors
Polysomnography and pain
Sleep architecture
Electroencephalography power spectral analysis
Circadian regulation of sleep and pain
Conclusion
Bibliography
42 COVID-19 and sleep
Sleep in uninfected individuals during the pandemic
Sleep in those infected with SARs-COV-2
Respiratory system infection
Long-haul respiratory outcomes
Neurologic effects
Long-haul neurologic and psychiatric outcomes
Cardiovascular system
Long-haul cardiovascular outcomes
COVID-19–related sleep symptoms and disorders
Insomnia or Hypersomnia
Sleep-disordered breathing
Therapeutic considerations
Role of other preexisting sleep disorders
Changes in the practice of sleep medicine
The future
Bibliography
Section 13 Women’s Health
43 The menstrual cycle
Menstrual cycle physiology
Sleep across the menstrual cycle
Pubertal maturation
Menstrual cycle and Insomnia symptoms
Impact of the menstrual cycle on other sleep disorders
Polycystic Ovarian syndrome
Impact of sleep on menstrual function
Bibliography
44 Pregnancy and postpartum
First trimester
Second trimester
Third trimester
Sleep-disordered breathing
Restless legs syndrome
Labor and delivery
Postpartum sleep
Postpartum sleep and mental health
Narcolepsy and pregnancy
Summary
Bibliography
45 Midlife transition and menopause
Sleep disturbance during menopause
Vasomotor symptoms
Management options for sleep disturbance
Bibliography
46 Fibromyalgia and chronic fatigue syndrome
Introduction
Fibromyalgia
Clinical presentation and diagnosis
Pathogenesis
Sleep
Treatment
Myalgic Encephalomyelitis/Chronic Fatigue syndrome
Clinical presentation and diagnosis
Pathogenesis
Sleep
Treatment
Bibliography
Section 14 Diagnostic Assessment Methods in Adults
47 Polysomnography and home sleep test assessment methods in adults
Overview
Sleep staging
Recording
Electroencephalogram for brain activity
Eye movements
Electromyogram for skeletal muscle tone
Staging
Classification
Waves
Stages
Stage W.
Stage N1.
Stage N2.
Stage N3.
Stage R.
Smoothing rules
Arousal scoring
Electroencephalogram speeding and central nervous system arousals
Cyclic alternating pattern
Sleep-related breathing disorders
Recording technique
Definitions and scoring rules
Sleep apnea
Hypopnea
Respiratory effort–related arousals
Movements
Leg movement recording technique
Periodic leg movement scoring rules
Other movements
Electrocardiogram
Home sleep testing
Overall assessment
Sleep stage changes across the night
Sleep stage changes as a function of age
Parameters, pathophysiology, and interpretation
Other assessments and interpretation
Multiple sleep latency test
Maintenance of wakefulness test
Suggested immobilization test
Actigraphy
Summary
Bibliography
Section 15 Media Galleries
48 Gallery of polysomnographic recordings
Obstructive sleep apnea (OSA)
Central sleep apnea
Mixed and complex sleep apnea
Heart failure
Cardiac rhythm abnormalities
Neurologic diseases
Movement disorders
Genetic disorders
Stroke
Narcolepsy
REM sleep behavior disorder
Seizures
Head trauma
Multiple sclerosis
Artifacts in sleep recordings
49 Gallery of patient interview videos
Sleep-related breathing disorders
An 8-year-old male patient with sleep apnea (Video 49.1)
An 82-year-old female patient with sleep apnea (Video 49.2)
A 43-year-old female patient with down syndrome (Video 49.3)
Apnea with cardiovascular comorbidities (Video 49.4)
Apnea presenting as restless sleep (Video 49.5)
Apnea in a truck driver (Video 49.6)
Explaining the results (Video 49.7)
Teaching and CPAP mask fitting (Video 49.8)
Neurologic and other disorders
Undiagnosed narcolepsy patient with cataplexy (Video 49.9)
Thirty-five years of undiagnosed narcolepsy (Video 49.10)
Hallucinations in a male narcolepsy patient (Video 49.11)
Narcolepsy patient with sleep apnea (Video 49.12)
Restless legs syndrome in a male patient (Video 49.13)
Middle-aged female patient with restless legs syndrome (Video 49.14)
REM sleep behavior disorder (Video 49.15)
Parkinson disease with REM sleep behavior disorder and sleep apnea (Video 49.16)
Multiple sclerosis, sleep apnea, and hypnagogic hallucinations (Video 49.17)
Arnold-Chiari malformation (Video 49.18)
Syringomyelia (Video 49.19)
Becker muscular dystrophy (Video 49.20)
Psychiatric disorders (Video 49.21)
50 Gallery of sleep laboratory video findings
Obstructive sleep apnea
Apnea, restlessness in a child
Nasal obstruction and apnea
Arousal threshold to noise in obstructive sleep apnea
Obstructive sleep apnea, violent body movements
Obstructive sleep apnea, violent body movements (×10)
Atypical snoring after uvulopalatopharyngoplasty
Vigorous movements in obstructive sleep apnea (×10)
Obstructive sleep apnea in special populations
Obesity hypoventilation
Obesity hypoventilation, heart failure
Obesity hypoventilation, treated
Obesity hypoventilation, polysomnography with synchronized digital video
Obstructive sleep apnea in pregnancy
Postpartum obstructive sleep apnea
Postpartum obstructive sleep apnea, treated
Apnea in acromegaly
Apnea in acromegaly (×10)
Apnea and down syndrome
Upper airway resistance syndrome
Upper airway resistance syndrome, quiet snoring
Upper airway resistance syndrome, quiet snoring (×7)
Upper airway resistance syndrome, variable snoring
Upper airway resistance syndrome, variable snoring (×5)
Central sleep apnea and cheyne-stokes respiration
Idiopathic central apnea
Retinitis pigmentosa, central apnea
Central apnea, obesity
Obstructive sleep apnea and cheyne-stokes breathing
Pulmonary edema
Respiratory diseases
Asthma
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease, upper airway obstruction
Chronic obstructive pulmonary disease, airway secretions, periodic limb movement disorder
Chronic obstructive pulmonary disease, airway secretions, periodic limb movements during sleep (×10)
Overlap syndrome
Overlap syndrome, treated
Pulmonary fibrosis
Neurologic and other disorders
Restless legs syndrome, insomnia
Restless legs syndrome and periodic limb movements during sleep (×25)
Restless legs syndrome, sleep apnea
Restless legs syndrome, sleep apnea (×10)
Periodic limb movement disorder, apnea (×10)
Periodic limb movement disorder, subtle movements (×10)
Rapid eye movement sleep behavior disorder
Rapid eye movement sleep behavior disorder, loud vocalization
Non–rapid eye movement parasomnia, confusional arousal, loud vocalization
Rapid eye movement sleep behavior disorder, obstructive sleep apnea
Sleep paralysis
Delayed sleep phase syndrome
Epilepsy
Seizure involving the leg
Psychogenic “seizures” (x5)
Psychogenic “seizures,” edge enhanced
Index
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